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. 2024 Apr;16(4):e13535.
doi: 10.1111/1753-0407.13535.

Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand-A national retrospective cohort study

Barbara M Daly  1 , Zhenqiang Wu  2 , Krishnarajah Nirantharakumar  3 , Lynne Chepulis  4 , Janet A Rowan  5 , Robert K R Scragg  6
Affiliations

Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand-A national retrospective cohort study

Barbara M Daly et al. J Diabetes. 2024 Apr.

Abstract

Background: Gestational diabetes mellitus increases the risk of developing type 2 diabetes. The aim of this study is to compare cardiometabolic and renal outcomes for all women in New Zealand with gestational diabetes (2001-2010) with women without diabetes, 10-20 years following delivery.

Methods: A retrospective cohort study, utilizing a national dataset providing information for all women who gave birth between 1 January 2001 and 31 December 2010 (n = 604 398). Adolescent girls <15 years, women ≥50 years and women with prepregnancy diabetes were excluded. In total 11 459 women were diagnosed with gestational diabetes and 11 447 were matched (for age and year of delivery) with 57 235 unexposed (control) women. A national hospital dataset was used to compare primary outcomes until 31 May 2021.

Results: After controlling for ethnicity, women with gestational diabetes were significantly more likely than control women to develop diabetes-adjusted hazard ratio (HR) 20.06 and 95% confidence interval (CI) 18.46-21.79; a first cardiovascular event 2.19 (1.86-2.58); renal disease 6.34 (5.35-7.51) and all-cause mortality 1.55 (1.31-1.83), all p values <.0001. The HR and 95% CI remained similar after controlling for significant covariates: diabetes 18.89 (17.36-20.56), cardiovascular events 1.79 (1.52-2.12), renal disease 5.42 (4.55-6.45), and all-cause mortality 1.44 (1.21-1.70). When time-dependent diabetes was added to the model, significance remained for cardiovascular events 1.33 (1.10-1.61), p = .003 and renal disease 2.33 (1.88-2.88), p < .0001 but not all-cause mortality.

Conclusions: Women diagnosed with gestational diabetes have an increased risk of adverse cardiometabolic and renal outcomes. Findings highlight the importance of follow-up screening for diabetes, cardiovascular risk factors, and renal disease.

Keywords: cardiovascular disease; dyslipidemia; gestational diabetes; hypertension; renal disease; type 2 diabetes.

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Conflict of interest statement

There are no competing interests relevant to this study.

Figures

FIGURE 1
FIGURE 1
Total birth events in New Zealand between 2001 and 2010, 11 459 women diagnosed with gestational diabetes mellitus and 11 447 matched with control women (n = 57 235). GDM, gestational diabetes mellitus; MAT, National Maternity Collection.
FIGURE 2
FIGURE 2
Cumulative proportion of women diagnosed with gestational diabetes mellites and control women who developed diabetes (A), had cardiovascular event (B), renal disease (C), or all‐cause mortality (D). GDM, gestational diabetes mellitus.
FIGURE 3
FIGURE 3
Cumulative proportion of women diagnosed with GDM and control women dispensed two or more hypertensive medications (A) or two or more lipid modifying medications (B). GDM, gestational diabetes mellitus.
FIGURE A1
FIGURE A1
Exploring the Proportional Hazard Assumption—log(−log [survival]) against log(survival time) for each outcome.
See this image and copyright information in PMC

References

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    1. Stats New Zealand . Births and deaths: Year ended December 2021 (including abridged period life table) Wellington, New Zealand. 2022. Available from https://www.stats.govt.nz/information‐releases/births‐and‐deaths‐year‐en...
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